Depressed Doctors - A Silent Affliction

[جوري]

Depressed Doctors - A Silent Affliction

An analysis of the frequency and effects of depression amongst doctors
Justin Carey

‘Becoming depressed is like going blind, the darkness at first gradual, then encompassing; it is like going deaf, hearing less and less until a terrible silence is all around you, until you cannot make any sound of your own to penetrate the quiet’

Andrew Solomon - The Noonday Demon
​

Depression is more common than you think. Every year 40% of the population have quite severe feelings of depressed mood, of which about 20% will experience a clinical depression1. Despite its ubiquity depression remains surprisingly misunderstood. For every person who refuses to acknowledge that depression is even a ‘real’ illness there will be someone else who views an admission of suffering from depression as a sign of inexcusable weakness. Despite such views, and maybe in some part because of them, depression continues to take its toll in all areas of society including the medical profession.

Despite depression being common within the general population, its prevalence within the medical profession is rarely acknowledged. Formal research into the problem over the last decade describes higher than expected levels of stress, anxiety, addiction, depression and other emotional disturbance, as well as suicide, across the entire medical profession, from students to senior doctors2, 3. Members of the medical profession are more likely to become depressed than most other professional groups4 and are less likely to seek help. A number of reasons account for this:

• The emotional and physical demands associated with working on the frontline in the NHS
• The perceived and actual expectations associated with providing a service of care to the public (even if this is to the detriment of the individual carer)
• The prevailing stigma within the profession which implies that admitting that one isn’t coping will result in a loss of confidence and respect from one’s peers (with consequent negative career implications)

In addition to the personal cost of depression, a depressed doctor is potentially a less competent doctor. Our responsibility to ensure that patient care is not compromised obliges us all to acknowledge the extent of this problem and attempt to provide the support required to those who suffer from this insidious mental illness.

Depression can take a variety of forms. The guy who feels ‘fine’ but hasn’t had a good night’s sleep for ages and can’t remember the last time he really enjoyed anything and the girl who is haunted by suicidal thoughts and can’t find the motivation to get of bed are both afflicted by the same condition. It’s important to remember that depression is an illness and if you are unfortunate enough to suffer from it, it is not your fault. Depression can appear unannounced or may follow a significant event such as bereavement, the end of a relationship or failing an exam. If you find few things pleasurable or suffer from prolonged low mood and also have a few of the following:

• Trouble sleeping
• Changed appetite
• Feel constantly fatigued
• Mood varies during the day, commonly being lower in the morning
• Find it difficult to concentrate
• Feelings of hopelessness
• Have suicidal thoughts
• Feel guilty/lacking in self-worth and confidence
• Reduced libido

then you are most probably depressed.

As a student at a leading university, training to enter a respected profession, it may seem self-indulgent to concede that you are depressed. It is never easy to admit that you might need help, particularly in a competitive environment. As a medical practitioner you will constantly be faced with the pain of others and encounter people when they are often at their most vulnerable. They will look to you for support but it remains important not to neglect your own well-being as no-one benefits by you refusing to seek help.

Writing in the BMJ5 Dr Kay McKall outlined her struggle with depression. She aimed to shed some light on the bleakness that often faces those who are depressed and to challenge the stigma that surrounds the depressed patient. She states that people with depression rarely complain about feeling depressed and those with depression think they are to blame for the situation. Additionally, people with depression lack a sense of judgment or proportion which often results in depressed doctors not knowing that they are sick.

Being depressed doesn’t have to be a silent affliction. Once you acknowledge that you have a problem you have taken the biggest step towards recovery. There are a variety of support options available. Don’t be afraid to confide in a trusted friend or colleague as speaking about your problem may give you a new perspective on the situation. Things will often seem less hopeless once you stop endlessly mulling it over by yourself. Of course, talking with friends may not be possible or desirable. In such cases there are various options available at medical school, college and university level. Contact the medical school office to find out about the peer support scheme, and there should be something similar available at your college too. The university counselling service (01865270300, [email protected]) can provide counselling support in the short- or long-term.

If after talking to someone you feel no better, if you find yourself unable to cope or if you fear that you may harm yourself, contact your GP or college doctor. There you’ll find a listening ear and they will be able to suggest options (including medications) to help you through the crisis in the short-term. Your doctor will also be able to co-ordinate access to further support services which may be necessary to ensure your return to full health in due course. Your GP should also follow you up to monitor the progress of your recovery and prevent you falling back into depression.

Depression is more common within our profession than we care to admit. For those who struggle with this illness it can be a lonely battle, but no one need suffer in silence because there is help available. If you are depressed you may feel that there will be no end to your situation, but there is hope. We are fortunate to be part of a profession that offers hope to many through expertise and genuine compassion for others. Let us not be guilty of neglecting our own as we strive to become good doctors.

References

1. Collier, J.; Longmore, M; Duncan Brown, T. (1999) Oxford Handbook of Clinical Specialities. 5th ed. OUP.
2. Firth-Cozens, J. (2003) Doctors, their wellbeing, and their stress. BMJ;326p.670-1.
3. Caplan, R. P. (1994) Stress, anxiety, and depression in hospital consultants, general practitioners, and senior health service managers. BMJ;309p.1261-1263.
4. Dowrick, C. ‘Depressed Doctors’ http://www.priory.com/depdoc.htm
5. McKall, K. (2001) An insider’s guide to depression. BMJ;323.1011 (27 October).

Justin Carey is a fifth year medical student at Somerville College, Oxford.

http://www.medsci.ox.ac.uk/gazette/previousissues/56vol1/Part7




I realize that not many people care how their docs are feeling lol
but recently I think I am suffering a bout of depression or at least I think it is.. I have been doing so much research on the topic to see how I can best manage it on my own.. I think it might help me to hear and read of your experiences with this affliction.



I haven't experienced as dark a days as I am living now a day, although I should be considerably better off than when I was a student and certainly wasn't without problems back then..


I am not so much concerned with the dark thoughts and the black cloud that is hovering over my head day and night as much as the physical symptoms.. I never knew the body can suffer so much and not simply die of it. I hate the feeling of almost being tied to a thousand electrode that I am unable to shut off.. has anyone else experienced this?..
How do you deal with this affliction? I have to almost stop any activity I am doing to quell myself and it has become quite unbearable .. I can't focus on any other task as I am looking for neurologists and radiologists knowing full well what they will say.. there is nothing modern science can do for these sensations, yes there are pills but they are not without their own side effects .. no one dies of a rapid heart rate or sensation of choking or dizziness etc. that is true but living them and intellectualizing them are separate issues and I think maybe hearing your tales is the best route to help me get back to my belligerent old self faster :embarrass..


Jazkoum Allah khyran..

 

[KittenLover]

I would be depressed if I was a doctor also, seeing all the problems that people are going through, imagine if you was a doctor in a hospital and you saw people die

 

[جوري]

so true.. I am hoping that this thread will help people find support in other members with the same afflictions if they want to come forward and write of their experiences etc.

 

[Italianguy]

I hate to see you fel this way Ms. Skye. But at least you are taking action and have identified your depression, many don't. I too feel these these symtoms somtimes.....allot in the last month or so.imsad (well except for the suicidal part). The worst part is when someone refuses help or denies it totaly. I am in a famliy of doctors, engineers, and business owners, we deal with depression all the time. Sadly my father fell victim to his depression, (he was a doctor and a lawyer...Neurologist no less) and completely denied his depression and was very good at hiding it completely.......He took his own lifeimsad BUt it is his own fault i understand that.

You asked how one deals with this? My own method is to think of my father..how he could be selfish enough to take his own life with my brother and I around is beyond me? I just think about what it would be like if my son, wife and family would suffer if I stayed depressed.....or worse. Depression has to be treated, it is unfair to others who depend on us to be so.


God bless.


......and smile sis

 

[جوري]

your father committed suicide?
wow I am sorry to hear that.. that is quite tragic..

peace

 

[Italianguy]

your father committed suicide?
wow I am sorry to hear that.. that is quite tragic..

peace

Yes he did. When i was eight.

And thank you.

 

[KittenLover]

Sometimes I just want out of this test also

 

[syilla]

:salamext:

I'm sorry for the sadness you're having now ukhtee...InshaAllah the sadness is for our own good...and not the other way round.

The reality is the word are a sad place to live in... and I'm glad that this world is just temporary. I don't know whether i will enter Jannah...but hopefully i can meet Allah swt and InshaAllah it is better for me. Because Allah swt is the most fair.

And i do wish people will realise Islam is the only way to help this world. At least to help 'most' of the problem existing now. Why they build up all the shelters and jails when the 'human' itself not change. Islam teaches us to show the right path, be modest and humble, help others, not to oppress others and at the same time to give naseehah and da'wah every minutes and every seconds because humans need to be reminded everyday. When they say that 'im a good person but i don't need islam' is as if they are self conceited and self centered and think human doesn't need to be advise and be reminded so that this world will be a nicer place to live in. They seem doesn't understand that this world is so full of sadness and all because of the humans behaving bad and evil ways.

Everyday i drive back home... I'll cry and i know my crying is worthless ...just wasting up my energy when i needed it to do the house chores :hmm:

And i'm so grateful that Islam has teaches us that suicide is haraam

 

[Woodrow]

Just my own opinion based on views of colleagues of mine and family members who were/are in the medical field.

depression among doctors is very widespread. I doubt that it is the result of being in the proximity of death daily. although that is the factor most doctors probably feel is the cause.

I more suspect it is a combination of irregular hours, frequent fatigue and the stress of continuous education. a doctor never finishes training. Going into medical practice means a life time of further education and each day facing exams in which any erroneous answer means failure and end of a career. It is constant high stress with no relief and each day is more difficult than the day before.

Add to this a doctor is faced daily with making decisions that will affect the life of another person. A daily battle of moral decisions. A lifetime career with no room for error and having to make decisions that are beyond mortal ability.

Mental strain, physical exhaustion, emotional conflicts all adding up to be the ingredients for clinical and situational depression.


Add to this, especially in hospital settings, becoming aware of colleagues who chose the field for the wrong reasons and become involved in illegal and/or immoral activities.

 

[sur]

Not only depression, suicide also has been reported to have higher rate among docs than general population... & from my personel observation, smoking too, is much higher is docs(I am NOT a smoker though)...

One reason for depression in docs, that comes to my mind is that medicine has been made a fuss by too many exams & licensing requirements... NO other field has so many stages to go thru... Too many checks & balances...

(Just read now, Uncle Woodrow has given similar reasoning...)

 

[Woodrow]

Now the $99 question, how do we all handle depression? doctors are not the only ones who face depression, all of us do at one time or another. I probably faced my most difficult depression when I was in my mid 30s. I was not a very religious person at that time and was more agnostic than believing in any faith.

To be honest I can not recall what was the cause of my depressed feelings, just remember that time as seeming very bleak with no future. Yet, everything in my life was going very well. I was earning well above average income, had all the material luxuries I desired, happily married with 3 children. But, felt very low.


I wish I could say I knew why the depression ended, but it did. All I can say is that for some reason it was lifted from me.

 

[Italianguy]

Now the $99 question, how do we all handle depression? doctors are not the only ones who face depression, all of us do at one time or another. I probably faced my most difficult depression when I was in my mid 30s. I was not a very religious person at that time and was more agnostic than believing in any faith.

To be honest I can not recall what was the cause of my depressed feelings, just remember that time as seeming very bleak with no future. Yet, everything in my life was going very well. I was earning well above average income, had all the material luxuries I desired, happily married with 3 children. But, felt very low.


I wish I could say I knew why the depression ended, but it did. All I can say is that for some reason it was lifted from me.

It's a beautiful thing isn't it?...when your depression ended was most likely the time you realized God was the answer to all of your prayers, when you realized you had more purpose than just working and living, now glorifiying your creator. When you saw that everything you had, wife, kids, ...stuff, well paying job was all because God was guiding you even though you didn't know it and or might had denied Him. God be with you uncle. And your family.

I love it! WOOOOOOOOOOWEEEEEEEEEEEE

You asked the $99 question...that was just my $1, you know...just to bring it to $100.;D

 

[جوري]

Now the $99 question, how do we all handle depression? doctors are not the only ones who face depression, all of us do at one time or another. I probably faced my most difficult depression when I was in my mid 30s. I was not a very religious person at that time and was more agnostic than believing in any faith.

To be honest I can not recall what was the cause of my depressed feelings, just remember that time as seeming very bleak with no future. Yet, everything in my life was going very well. I was earning well above average income, had all the material luxuries I desired, happily married with 3 children. But, felt very low.


I wish I could say I knew why the depression ended, but it did. All I can say is that for some reason it was lifted from me.

I can deal with the sad mood.. the night without end, the days without hope.. it is the physical symptoms that accompany it that are making it all the more hellish..well that is to say they are sx. of depression and not some organic pathology .. I want these sensations, feeling wired, fatigued the general lassitude amongst many others to end..
I don't know how to go through another day feeling like this.. sob7an Allah


Anyhow.. al7mdlillah.. I didn't want to complain.. I just want to feel better insha'Allah...

 

[Woodrow]

I can deal with the sad mood.. the night without end, the days without hope.. it is the physical symptoms that accompany it that are making it all the more hellish..well that is to say they are sx. of depression and not some organic pathology .. I want these sensations, feeling wired, fatigued the general lassitude amongst many others to end..
I don't know how to go through another day feeling like this.. sob7an Allah


Anyhow.. al7mdlillah.. I didn't want to complain.. I just want to feel better insha'Allah...

The physical aspects of depression are very real and very similar to the symptoms of illnesses caused by organic pathogens.There is a very strong connection between the psyche and the physical.

Pained Soul=pained body=pained soul=pained body.

One can not be treated without treating the other. Generally the most workable approach is to begin by rebuilding the body. during this time it is essential to begin a routine of proper nutrition, rest and exercise. The psyche will make this difficult as there is no emotional desire to do so.
A person is truly their own worse enemy.

People tend to forget the medical value of worship and the healing power of worship. During this time it is good to force oneself back into a pattern of regular prayer and Initially it will seem almost hypocritical as there will be little if any sincerity. But, as the body begins to heal, there will be an increase in eemaan.

Depression requires a holistic approach and every facet of a person's psyche, soul and body needs to be treated.

To treat depression requires the combined efforts of self, family, friends, nutritionists, physicians, and Allaah(swt). This is also the best time to make du'a for others. Making du'a for others is one of the few things we are capable of doing for others during this time of trial. Do not be concerned if the du'as seem to be sloppy and poorly done. A person does not get graded on perfection, as humankind is incapable of perfection.

So to sum it all up: make du'a for others, follow the advice of health practitioners and nutritionists, ask everybody you know to make dua for you and know that you are in all of our du'as.

And strive to have opening of the Glorious Qur'an to be as frequent as your heart beat.

You are in My wife's and my du'as and may the passage through this tunnel of this darkness be finished and open into a time of brightness, health and prosperity.

 

[Trumble]

Du'a I can't manage for obvious reasons, but certainly my best wishes and hopes go out to Gossamer skye and anyone else here with similar problems.

I certainly understand, I'm currently taking fluoxetine (and until a few days ago diazepam as well); I came close to a total breakdown following my mother's death and 'issues' with my father arising subsequently, and indeed I only returned to work today after six weeks away.

'Depression' is an unfortunate word partly because far too many people are unaware of the distinction between clinical depression, and the common usage of just feeling sad or down, but mostly because it isn't even really an accurate description. Certainly in my experience recently I felt more 'blank' than 'sad', I suppose, combined with both a total inability to concentrate on anything (including meditation, and leisure pursuits) and to get severely agitated when stressed. I am getting there now, though, I think. For me returning to work was a very positive thing, in that it signals something of a return to normality, but it must be awful for those whose depression/anxiety/stress is wholly or partially the result of pressures of their job. imsad

 

[جوري]

Thank you everyone..

Trumble, I can certainly relate that there is no set of criteria to designate to these feelings, all of a sudden I wonder who sat down and came up with that list.. perhaps they are more lucid outlines than folks can have described in words...
The fact that I can't even make my usual drive everyday and have to take regular streets instead of the highway so I can pull over with every two blocks as every task absolutely every last task seems insurmountable to me is perhaps one of the most worrying outcomes of this to me personally. I think I can't get control over the future, how I am feeling or just immediate events or this 'wired' feeling that I am in all the time, I oscillate between wired and foggy.. I can't cry but when I do just for release I am in hysterics..

I don't know what is causing any of this.. I know I am stressed by life and work but no more than what I am usually accustomed .. I need to know that there is an end to this.. I keep asking myself when I'll feel better.. maybe next week but next week comes and I am worse.. I feel like I am losing my mind, and I absolutely forgotten how to eat that I find my elderly mother making food for me even though she has her own health problems, because I just forget that I need to eat.. I have no appetite for anything at all, except my desire to feel better and not succumb but the harder I try the more anxious and out of control I feel...

imsad imsad imsad

 

[Italianguy]

Thank you everyone..

Trumble, I can certainly relate that there is no set of criteria to designate to these feelings, all of a sudden I wonder who sat down and came up with that list.. perhaps they are more lucid outlines than folks can have described in words...
The fact that I can't even make my usual drive everyday and have to take regular streets instead of the highway so I can pull over with every two blocks as every task absolutely every last task seems insurmountable to me is perhaps one of the most worrying outcomes of this to me personally. I think I can't get control over the future, how I am feeling or just immediate events or this 'wired' feeling that I am in all the time, I oscillate between wired and foggy.. I can't cry but when I do just for release I am in hysterics..

I don't know what is causing any of this.. I know I am stressed by life and work but no more than what I am usually accustomed .. I need to know that there is an end to this.. I keep asking myself when I'll feel better.. maybe next week but next week comes and I am worse.. I feel like I am losing my mind, and I absolutely forgotten how to eat that I find my elderly mother making food for me even though she has her own health problems, because I just forget that I need to eat.. I have no appetite for anything at all, except my desire to feel better and not succumb but the harder I try the more anxious and out of control I feel...

imsad imsad imsad

OMG! Please ms. Skye try to eat more. 2 years ago i was very depressed and literaly didn't eat for weeks( no more than 1) at a time. I just didn't have an apetite and when i thought of food i just didn't want it. I scared everyone. I lost over 65 pounds in less than 2 months, and thats way to much to be healthy. I lost color and looked sick. Plus i was very weak. I didn't talk to people, i didn't want to be around people, I would even lock my office door everyday so I didn't have to see my employees! I would stay in the office by myself from 5 am to 11pm, most of the time just staring at the wallsimsad. Business was weakining as a result. I am blessed to have good office managers who made excuses for me for a month.

Food is important. please eat.

May God take away from you this pain, and bring upon you good health, and happiness, may he guide you through these hard times, and bless you with a brighter future.Amen

 

[syilla]

^^^ true... food does make a difference. Eat ukhtee...even only 100 plus, it'll make you feel better.

 

[CosmicPathos]

my periods of depression usually involve disconnection from the world and the humans in it. I feel a sudden urge to become non-existent. Disappear into the murky surroundings with no trace left behind. In search of some peace. I asked my mom other day that why are humans considered social animals and why do humans need other humans to live? She gave a very simple example of how a human newborn is totally dependent on parents and is a weakling. Without the help from parents, this weakling will die. So her point was that "depending on other humans" is in man's nature and to go against it is to go against nature.

I understand all that. But being obsessed with iconoclasm, I always find urges to go against nature .... But I think after recent discussion with mom about this, I would try to avoid this phase in my depression.

I've been going through cycles of depression for the last 1.5 years. When I visited Makkah last year, I overcame them as I tried to solidify my faith there. Tried to remove doubts by reading the Quran in front of Kaaba. What I realized was that questions of philosophical nature are endless and I will ruin my life if I continue to find answers to all questions that I have and die with doubts .... and these doubts are always related to my depression phases. So I am trying to not get depressed. To that effect, I want to give myself very little time to think about things. Its a slippery slope. Better get out and do some hands-on stuff. Hopefully my questions will be answered if I get to see Allah, inshAllah. And this depression and doubt stuff started after constant rejections from professional schools.

Even my friend had to tell me to stop being so obsessed with finding answers at the expense of giving up living a "normal" life. My social life is 0 at the moment.

What makes me angry though is that people and family friends consider my introvertedness as pride and arrogance. And nothing could be farther from the truth. They just cant see the sinking boat on which I am traveling.

 

[Italianguy]

my periods of depression usually involve disconnection from the world and the humans in it. I feel a sudden urge to become non-existent. Disappear into the murky surroundings with no trace left behind. In search of some peace. I asked my mom other day that why are humans considered social animals and why do humans need other humans to live? She gave a very simple example of how a human newborn is totally dependent on parents and is a weakling. Without the help from parents, this weakling will die. So her point was that "depending on other humans" is in man's nature and to go against it is to go against nature.

I understand all that. But being obsessed with iconoclasm, I always find urges to go against nature .... But I think after recent discussion with mom about this, I would try to avoid this phase in my depression.

I've been going through cycles of depression for the last 1.5 years. When I visited Makkah last year, I overcame them as I tried to solidify my faith there. Tried to remove doubts by reading the Quran in front of Kaaba. What I realized was that questions of philosophical nature are endless and I will ruin my life if I continue to find answers to all questions that I have and die with doubts .... and these doubts are always related to my depression phases. So I am trying to not get depressed. To that effect, I want to give myself very little time to think about things. Its a slippery slope. Better get out and do some hands-on stuff. Hopefully my questions will be answered if I get to see Allah, inshAllah. And this depression and doubt stuff started after constant rejections from professional schools.

Even my friend had to tell me to stop being so obsessed with finding answers at the expense of giving up living a "normal" life. My social life is 0 at the moment.

What makes me angry though is that people and family friends consider my introvertedness as pride and arrogance. And nothing could be farther from the truth. They just cant see the sinking boat on which I am traveling.

Well, my scientific friend, what can we do to help?? I think I know a way to make you smile I mean come on....you have a Christian dude right here you can pick on;D I don't mind really...as long as it brings a smile across you face.

Come on try it, i know your thinking it....come on i think i see it....there it is i knw you could do it.

You gotta get out a little more Wahabi. Put a patch in that boat and start sailing on a journey of happiness.....omg, that was so cheesy i'm sorry;D